Mortalidad en accidentes por moto en Venezuela, y su relación con Políticas Públicas de seguridad vial y preventiva,1996-2018 / Mortality in motorcycle accidents in Venezuela and relationship with public road safety and preventive policies, 1996 - 2018

Los accidentes de tránsito son un problema de salud pública de gran magnitud y gravedad, en las Américas; Venezuela ocupa un lugar destacado por su alta incidencia. El objetivo de la investigación es establecer la relación entre las políticas públicas para la prevención de los accidentes de motocicletas, y las tasas de mortalidad. Metodología: Estudio documental retrospectivo de las políticas viales y las tasas de mortalidad específicas de lesionados por accidentes de motocicletas en Venezuela durante el período 1996-2018. Resultados: como causa de muerte en Venezuela (2000-2018), representa casi 7% del total, entre 6 a 50% del total de las muertes por accidentes de tránsito terrestre y se mantiene muy alta al final del período, con fallecidos por motocicletas sobre 25%. La elevación de la curva endémica de mortalidad ocurrió simultáneamente al aumento en la producción e importación de motocicletas, y cayó durante la crisis económica, en el año 2014. La legislación actualizada mas no acatada en esta materia, es notoria Conclusiones: Los accidentes de motocicleta son un problema de salud pública de primer orden en Venezuela asociadas al clima económico y social, las tasas de mortalidad tuvieron su máxima meseta de elevación durante la bonanza petrolera 2005-2013. Las políticas asociadas a la prevención de accidentes viales en moto están fragmentadas, son ineficientes y reactivas a situaciones complejas, deficientemente aplicadas por los organismos de tránsito responsables a escala nacional, regional y municipal.

Introduction. Traffic accidents are a public health problem of great magnitude and gravity in the Americas; Venezuela occupies a prominent place for its high incidence. The objective of the research is to establish the relationship between public policies for the prevention of motorcycle accidents, and mortality rates. Methodology: Retrospective documentary study of road policies and specific mortality rates of those injured by motorcycle accidents in Venezuela during the period 1996-2018. Descriptive statistical analysis with trend lines, frequency distributions and annual average rates. Results: cause of death in Venezuela (2000-2018), represents almost 7% of the total. The burden of motorcycle injury deaths represents between 6 to 50% of total road traffic fatalities and remains very high at the end of the period, with motorcycle fatalities over 25%. The elevation of the endemic mortality curve occurred simultaneously with the increase in the production and import of motorcycles, and fell concomitantly with the economic crisis in 2014. Conclusions: Motorcycle accidents are a public health problem of the first order in Venezuela associated with the economic and social climate, mortality rates had their maximum plateau of elevation during the oil economic boom 2005-2013. The policies associated with the prevention of road accidents by motorcycle are fragmented, inefficient and reactive to complex situations and poorly applied by the responsible traffic agencies at national, regional and municipal level.

Shifting patterns of disparities in unintentional injury mortality rates in the United States, 1999-2016 / Tendencias cambiantes en las disparidades en las tasas de mortalidad por traumatismo no intencional en Estados Unidos entre 1999 y 2016 / Mudança nos padrões de disparidade nas taxas de mortalidade por lesões acidentais nos Estados Unidos, 1999-2016

ABSTRACT Objectives. To analyze changes in racial/ethnic disparities for unintentional injury mortality from 1999-2016. Methods. Mortality data are from the National Center for Health Statistics (NCHS) for all unintentional injuries, analyzed separately by injury cause (motor vehicle accidents [MVA], poisonings, other unintentional) for white,black, and Hispanic populations within four age groups: 15-19, 20-34, 35-54, 55-74 for males and for females. Results. Rates across race/ethnic groups varied by gender, age and cause of injury. Unintentional injury mortality showed a recent increase for both males and females, which was more marked among males and for poisoning in all race/ethnic groups of both genders. Whites showed highest rates of poisoning mortality and the steepest increase for both genders, except for black males aged 55-74. MVA mortality also showed an increase for all race/ethnic groups, with a sharper rise among blacks, while Hispanics had lower rates than either whites or blacks. Rates for other unintentional injury mortality were similar across groups except for white women over 55, for whom rates were elevated. Conclusions. Data suggest while mortality from unintentional injury related to MVA and poisoning is on the rise for both genders and in most age groups, blacks compared to whites and Hispanics may be suffering a disproportionate burden of mortality related to MVAs and to poisonings among those over 55, which may be related to substance use.

RESUMEN Objetivos. Analizar cambios en las disparidades por raza y grupo étnico en materia de mortalidad por traumatismos no intencionales de 1999 al 2016. Métodos. Los datos de mortalidad de todos los traumatismos no intencionales provienen del Centro Nacional de Estadísticas Sanitarias y se han analizado por separado por causa de traumatismo (colisiones automovilísticas, intoxicaciones y otras causas no intencionales) y por población blanca, negra e hispana, tanto en hombres como en mujeres, en cuatro grupos etarios: de 15 a 19, de 20 a 34, de 35 a 54 y de 55 a 74. Resultados. Las tasas en todos los grupos raciales y étnicos variaron según el sexo, la edad y la causa del traumatismo. La mortalidad por traumatismo no intencional mostró un aumento reciente tanto en hombres como en mujeres, que fue más marcado en el caso de los hombres, y por intoxicación en todos los grupos raciales y étnicos de ambos sexos. La población blanca mostró las tasas más elevadas de mortalidad por intoxicación y el incremento más acentuado en ambos sexos, con excepción de los hombres negros entre 55 y 74 años de edad. La mortalidad por colisión automovilística también registró un aumento en todos los grupos raciales y étnicos, con un incremento mayor en la población negra, mientras que la población hispana mostró tasas inferiores que la blanca o la negra. Las tasas de mortalidad por otros traumatismos no intencionales fueron similares en todos grupos salvo en el caso de las mujeres blancas de más de 55 años, cuyas tasas mostraron un incremento. Conclusiones. Los datos indican que, si bien la mortalidad por traumatismo no intencional relacionada con colisiones automovilísticas e intoxicación está en alza en ambos sexos y en la mayoría de los grupos etarios, la población negra en comparación con la blanca y la hispana puede estar presentando una carga desproporcionada de mortalidad relacionada con colisiones automovilísticas e intoxicación en personas mayores de 55, que podrían estar relacionado con el consumo de sustancias psicoactivas.

RESUMO Objetivos. Analisar as mudanças nas disparidades étnico-raciais da mortalidade por lesões acidentais no período 1999-2016. Métodos. Os dados de mortalidade foram obtidos do Centro Nacional de Estatísticas de Saúde (NCHS) dos Estados Unidos para todos os tipos de lesões acidentais e analisados em separado por causa de lesão (acidentes de trânsito de veículos a motor, envenenamento/intoxicação e outros tipos de acidentes) em grupos populacionais de brancos, negros e hispânicos de ambos os sexos divididos em quatro faixas etárias: 15-19, 20-34, 35-54 e 55-74 anos. Resultados. As taxas de mortalidade nos grupos étnico-raciais variaram segundo sexo, idade e causa de lesão. Houve um aumento recente na mortalidade por lesões acidentais nos sexos masculino e feminino, sendo mais acentuado no sexo masculino e por envenenamento/intoxicação em todos os grupos étnicos-raciais de ambos os sexos. A população branca apresentou as maiores taxas de mortalidade por envenenamento/intoxicação e o aumento mais acentuado na mortalidade em ambos os sexos, exceto por homens negros de 55-74 anos. Ocorreu também um aumento da mortalidade por acidentes de trânsito de veículos a motor em todos os grupos étnico-raciais, sendo mais acentuado em negros, e a mortalidade na população hispânica foi menor que em brancos ou negros. As taxas de mortalidade por outros tipos de acidentes foram semelhantes em todos os grupos, exceto em mulheres brancas acima de 55 anos que apresentaram taxas elevadas. Conclusões. Os dados analisados indicam que, apesar de a mortalidade por lesões acidentais por acidentes de trânsito de veículos a motor e envenenamento/intoxicação estar aumentando em ambos os sexos e na maioria das faixas etárias, em comparação a brancos e hispânicos, os negros possivelmente sofrem um ônus desproporcional de mortalidade por acidentes de trânsito e envenenamento/intoxicação no grupo acima de 55 anos que pode estar associada ao uso de substâncias químicas.

Muerte violenta en la región Manzanillo. 2017-2019 / Violent death in the Manzanillo region. 2017-2019

Introducción: las muertes violentas representan un capítulo abierto al estudio desde todos los ángulos profesionales. En su génesis, producción y consecuencias participan causas sociales, económicas, culturales, emocionales, médicas y otras que, en conjunto, trazan un cuadro sumamente complejo. Objetivo: caracterizar la muerte violenta en la región de Manzanillo. Método: se realizó un estudio descriptivo retrospectivo de 443 casos de fallecidos de manera violenta, registrados en el servicio de Medicina Legal del Hospital Celia Sánchez Manduley, en el período comprendido de enero del 2017 a diciembre del 2019. Se midieron variables como: etiología médico-legal, edad, sexo, ocupación, municipio, trimestre del año, día de la semana, causa básica de muerte y sistemas o aparatos afectados. Resultados: los accidentes predominaron como causa etiológica, los suicidios y homicidios fueron los que más aportaron a esta problemática; el sexo masculino predominó en cada una de las etiologías, mientras que los jubilados alcanzaron mayor frecuencia tanto para los accidentes como para los suicidios y los obreros no calificados y desocupados para los homicidios. Conclusiones: el municipio Manzanillo mostró un mayor número de casos, así como el tercer trimestre del año y los días del fin de semana. El ahorcamiento constituyo la causa básica de muerte fundamental y el sistema respiratorio el más afectado(AU)

Introduction: violent deaths represent an open chapter to study from all professional angles. In its genesis, production and consequences involved social, economic, cultural, emotional, medical and other causes that, together, draw a very complex picture. Objective: to characterize the violent death in the Manzanillo region. Method: a retrospective descriptive study of 443 cases of violent deaths was registered, registered in the Legal Medicine service of the Celia Sánchez Manduley Hospital, in the period from January 2017 to December 2019. Variables such as: medical etiology were measured-legal, age, sex, occupation, municipality, quarter of the year, day of the week, basic cause of death and affected systems or devices. Results: accidents predominated as an etiological cause, suicides and homicides were the ones that contributed most to this problem; the male sex prevailed in each of the etiologies, while the retirees reached a higher frequency for accidents as well as for suicides and unskilled and unemployed workers for homicides. Conclusions: the Manzanillo municipality showed a greater number of cases, as well as the third quarter of the year and the days of the weekend. The hanging was the basic cause of fundamental death and the respiratory system the most affected(EU)

Craniofacial injuries by firearms projectiles: An analysis of 868 deaths in the five regions of Brazil.

Firearms injuries have a legal and medico-legal importance, and are especially lethal when they reach the craniofacial regions of the victim. The present study aims to identify the characteristics of craniofacial lesions resulting from firearm projectiles, to register the most affected craniofacial regions by this type of injury and to verify the demographic profile of the victims. A retrospective study was carried out on the autopsy records produced in the first semester of 2015, in five Institutes of Legal Medicine in Porto Velho, situated in the cities of João Pessoa, Vitória, Porto Alegre and Brasília. Data extracted included sex, skin color and age of the victim, craniofacial region reached, shooting distance, shape and size of the injuries and manner of death (homicide, suicide or accident). Based on the 868 reports analyzed, it was possible to observe 1700 entrance lesions of firearm projectiles in craniofacial regions. Among cases of known manner of death, homicides were the most frequent (97.0%). It was observed a higher frequency of male victims (93.3%), mixed race (62.0%), between the ages of 12 and 29 years (59.4%). In all cases considered as suicide or accident there was only one entrance wound, but in 82.8% of the homicides there were multiple gunshot wounds. The craniofacial most affected regions were temporal (25.2%) and occipital (19.8%). The most common sites of projectiles exit were the temporal (25.3%) and parietal (16.1%). All cases of suicide were related to contact shot (69.2%) or close-range shot (30.8%), and among the homicides the distant range shots were more frequent (54.0%). The shape of entrance wounds was mostly circular (56.8%) and oval (31.3%), and among the exit injuries, the lesions were irregular (43.3%) and starry (24.1%). The entrance wounds showed smaller sizes than the exit lesions (p < 0.0001). The data obtained are useful for guiding research that takes into account craniofacial trauma caused by firearm projectiles, makes it possible to compare this data with those of other countries and can base investigative conclusions based on the analyzes discussed in the present work.

Improvement of the unspecified external causes classification based on the investigation of death in Brazil in 2017. / Melhoria da classificação das causas externas inespecíficas de mortalidade baseada na investigação do óbito no Brasil em 2017.

BACKGROUND: Unspecified causes of death are among the traditional indicators of quality of information. OBJECTIVE: To verify the performance of the 60 cities in the Data for Health Initiative project and to analyze the reclassification of unspecified external causes of death (UEC). METHODS: Using the 2017 records from the Mortality Information System, the proportion and percent change in UEC were compared after investigation between project cities and other cities, and the percent of reclassification to specific external causes was calculated. RESULTS: The project cities comprised 52% (n = 11,759) of the total UEC in Brazil, of which 64.5% were reclassified after investigation, whereas the other cities reclassified 31% of UEC. Results were similar for men, youth, blacks, metropolitan cities, the Southeast region, and deaths attested by forensic institutes. In the project cities, pedestrian traffic accidents were external causes with greater reclassification. In men, the UEC was reclassified to homicides (23.8%) and accident of terrestrial transportation (ATT) (11.1%), with motorcyclists (4.4%) and pedestrians (4.3%) being the most prominent. In women, these causes were changed to other accident causes (20.8%), ATT (10.6%) and homicides (7.9%). UEC changed to ATT (18.3%) in the age groups of 0-14 years old and to homicides (32.5%) in the age groups of 15-44 years. CONCLUSION: The project cities obtained better results after investigation of UEC, enabling analysis of the reclassification to specific causes by sex and age groups.

INTRODUÇÃO: Causas inespecíficas de mortalidade estão entre os indicadores tradicionais de qualidade da informação. OBJETIVO: Verificar o desempenho das 60 cidades do projeto Dados para a Saúde e analisar a reclassificação das causas externas inespecíficas de mortalidade (CEI). MÉTODOS: A partir de registros de 2017 do Sistema de Informações sobre Mortalidade, comparou-se proporções e variações percentuais após investigação das CEI, entre cidades do projeto e demais cidades, e calculou-se percentual de reclassificação para causas específicas. RESULTADOS: As cidades do projeto concentraram 52% (n = 11.759) das CEI do Brasil, das quais 64,5% foram reclassificadas após investigação, enquanto as demais cidades reclassificaram 31%. Resultados foram semelhantes para homens, jovens, negros, cidades metropolitanas, região Sudeste, e em eventos atestados por institutos forenses. Nas cidades do projeto, acidentes de pedestres foram causas com maior reclassificação. Em homens, as CEI migraram para homicídios (23,8%) e acidentes de transporte terrestre (ATT) (11,1%), com destaque para motociclistas (4,4%) e pedestres (4,3%). Em mulheres, essas causas foram alteradas para outras causas acidentais (20,8%), ATT (10,6%) e homicídios (7,9%). CEI migraram para ATT (18,3%) no grupo de idade de 0 a 14 anos, e homicídios (32,5%) no grupo de 15 a 44 anos. CONCLUSÃO: As cidades do projeto obtiveram melhores resultados após investigação de CEI, possibilitando analisar a reclassificação para causas específicas, por sexo e faixas etárias.

Melhoria da classificação das causas externas inespecíficas de mortalidade baseada na investigação do óbito no Brasil em 2017 / Improvement of the unspecified external causes classification based on the investigation of death in Brazil in 2017

RESUMO Introdução: Causas inespecíficas de mortalidade estão entre os indicadores tradicionais de qualidade da informação. Objetivo: Verificar o desempenho das 60 cidades do projeto Dados para a Saúde e analisar a reclassificação das causas externas inespecíficas de mortalidade (CEI). Métodos: A partir de registros de 2017 do Sistema de Informações sobre Mortalidade, comparou-se proporções e variações percentuais após investigação das CEI, entre cidades do projeto e demais cidades, e calculou-se percentual de reclassificação para causas específicas. Resultados: As cidades do projeto concentraram 52% (n = 11.759) das CEI do Brasil, das quais 64,5% foram reclassificadas após investigação, enquanto as demais cidades reclassificaram 31%. Resultados foram semelhantes para homens, jovens, negros, cidades metropolitanas, região Sudeste, e em eventos atestados por institutos forenses. Nas cidades do projeto, acidentes de pedestres foram causas com maior reclassificação. Em homens, as CEI migraram para homicídios (23,8%) e acidentes de transporte terrestre (ATT) (11,1%), com destaque para motociclistas (4,4%) e pedestres (4,3%). Em mulheres, essas causas foram alteradas para outras causas acidentais (20,8%), ATT (10,6%) e homicídios (7,9%). CEI migraram para ATT (18,3%) no grupo de idade de 0 a 14 anos, e homicídios (32,5%) no grupo de 15 a 44 anos. Conclusão: As cidades do projeto obtiveram melhores resultados após investigação de CEI, possibilitando analisar a reclassificação para causas específicas, por sexo e faixas etárias.

ABSTRACT Background: Unspecified causes of death are among the traditional indicators of quality of information. Objective: To verify the performance of the 60 cities in the Data for Health Initiative project and to analyze the reclassification of unspecified external causes of death (UEC). Methods: Using the 2017 records from the Mortality Information System, the proportion and percent change in UEC were compared after investigation between project cities and other cities, and the percent of reclassification to specific external causes was calculated. Results: The project cities comprised 52% (n = 11,759) of the total UEC in Brazil, of which 64.5% were reclassified after investigation, whereas the other cities reclassified 31% of UEC. Results were similar for men, youth, blacks, metropolitan cities, the Southeast region, and deaths attested by forensic institutes. In the project cities, pedestrian traffic accidents were external causes with greater reclassification. In men, the UEC was reclassified to homicides (23.8%) and accident of terrestrial transportation (ATT) (11.1%), with motorcyclists (4.4%) and pedestrians (4.3%) being the most prominent. In women, these causes were changed to other accident causes (20.8%), ATT (10.6%) and homicides (7.9%). UEC changed to ATT (18.3%) in the age groups of 0-14 years old and to homicides (32.5%) in the age groups of 15-44 years. Conclusion: The project cities obtained better results after investigation of UEC, enabling analysis of the reclassification to specific causes by sex and age groups.

Underreporting of fatal poisonings in Brazil - A descriptive study using data from four information systems.

Poisoning is a worldwide problem that involves individuals of all ages and a range of chemicals. In this study, fatal poisoning cases that occurred in the Federal District of Brazil (DF) from 2009 to 2013 were described using information from four systems, and the reasons for underreporting of each system were discussed. Data were obtained from the mortality information system (SIM), the notifiable disease information system (SINAN), the poison information center (CIT), and the forensic medicine institute (IML) of the DF. In total, 288 cases were reported to SIM, 18 to SINAN, 29 to CIT and 101 cases identified in the IML. SIM data indicated a prevalence of 2.24 cases/year/100,000 individuals in the DF, higher than the national estimation (1.36). After eliminating the 98 duplicate cases among the systems, 338 fatal unique cases were identified, from which 74.0% were reported in only one system (mainly the SIM), 23.4% in two systems, 8 cases in three systems and only 1 case was reported in the four systems. Over two thirds of the 338 fatalities involved men (67.4%), and 46.9% involved individuals aged 20-39 years. Medications were the main agent involved (49.4%), followed by pesticides (29.9%). The fatalities occurred mainly after unintentional exposure (50.8%) and suicide (47.7%, of which 53.5% involved pesticides). These results confirmed the previous hypothesis that none of the information systems could capture the whole picture of fatal poisonings in the DF. Underreporting was found in all systems, indicating the need to improve the information quality and the coordination of data reporting, so that health authorities can better understand and reduce these fatalities.

Unintentional and self-poisoning mortalities in Mexico, 2000-2012.

INTRODUCTION: Poisoning remains a major worldwide public health problem. Mortality varies by country, region and ethnicity. The objective of this study is to analyze recent trends in poisoning mortality in the Mexican population. METHODS: Data regarding mortality induced by poisoning was obtained from a publicly available national database maintained by the National Institute of Statistics and Geography. RESULTS: During the period from 2000 to 2012, average mortality rates for unintentional and self-poisoning were 1.09 and 0.41 per 100000 population, respectively. The highest mortality rate for unintentional poisoning was in older individuals of both genders while the highest mortality for self-poisoning was in older men and young women. Additional studies are needed in Mexico, especially those that analyze risk factors in older individuals and young women.

Profile of mortality from external causes among Seventh-day Adventists and the general populations. / Perfil de mortalidade por causas externas entre Adventistas do Sétimo Dia e a população geral.

This paper aimed to compare the profile of mortality from external causes among Seventh-day Adventists and the general population of Espírito Santo from 2003 to 2009. A search of Adventists was performed in the nominal database of the Mortality Information System containing data on Adventists provided by the administrative offices of the institution. Deaths from external causes occurred during the study period were then divided into two groups: Adventists and the general population. Adventists had lower proportional mortality from external causes (10%) than the general population (19%), and males were the main reason for this difference. In both groups, deaths prevailed in the 20-29 years age group. Deaths from accidental causes were most significant among Adventists (68.08%), while deaths from intentional causes related to assault and self-inflicted injuries were more significant in the general population (53.67% of all deaths). The standardized mortality ratio for external causes was 41.3, thus, being Adventist reduced mortality by 58.7%. It is believed that the benefit of Adventists observed for mortality from external causes is related to this group's abstinence from alcohol consumption.

Perfil de mortalidade por causas externas entre Adventistas do Sétimo Dia e a população geral / Profile of mortality from external causes among Seventh-day Adventists and the general populations

Resumo Este estudo teve por objetivo comparar o perfil de mortalidade por causas externas entre Adventistas do Sétimo Dia e população geral do Espírito Santo no período de 2003 a 2009. Realizou-se busca dos Adventistas no banco nominal do Sistema de Informação sobre Mortalidade de posse das informações dos Adventistas fornecidas pelas sedes administrativas da instituição. Os óbitos por causas externas ocorridos no período estudado foram então separados em dois grupos: Adventistas e população geral. Os Adventistas apresentaram menor mortalidade proporcional por causas externas (10%) que a população geral (19%), sendo o sexo masculino o principal responsável por essa diferença. Em ambos os grupos os óbitos predominaram na faixa de 20 a 29 anos. As mortes por causas acidentais foram mais expressivas entre os Adventistas (68,08%) enquanto as mortes por causas intencionais relacionadas às agressões e lesões autoprovocadas foram mais significativas na população geral (53,67% de todas as mortes). A razão de mortalidade padronizada para as causas externas foi 41,3, sendo assim ser Adventista reduziu a mortalidade em 58,7%. Acredita-se que o benefício dos Adventistas verificado em relação à mortalidade por causas externas possa estar relacionado à recomendação de abstinência do consumo de álcool por esse grupo.

Abstract This paper aimed to compare the profile of mortality from external causes among Seventh-day Adventists and the general population of Espírito Santo from 2003 to 2009. A search of Adventists was performed in the nominal database of the Mortality Information System containing data on Adventists provided by the administrative offices of the institution. Deaths from external causes occurred during the study period were then divided into two groups: Adventists and the general population. Adventists had lower proportional mortality from external causes (10%) than the general population (19%), and males were the main reason for this difference. In both groups, deaths prevailed in the 20-29 years age group. Deaths from accidental causes were most significant among Adventists (68.08%), while deaths from intentional causes related to assault and self-inflicted injuries were more significant in the general population (53.67% of all deaths). The standardized mortality ratio for external causes was 41.3, thus, being Adventist reduced mortality by 58.7%. It is believed that the benefit of Adventists observed for mortality from external causes is related to this group's abstinence from alcohol consumption.

Mortality and years of life lost by interpersonal violence and self-harm: in Brazil and Brazilian states: analysis of the estimates of the Global Burden of Disease Study, 1990 and 2015. / Mortalidade e anos de vida perdidos por violências interpessoais e autoprovocadas no Brasil e Estados: análise das estimativas do Estudo Carga Global de Doença, 1990 e 2015.

OBJECTIVE:: To analyze mortality and years of life lost due to death or disability (disability-adjusted life years - DALYs) for interpersonal violence and self-harm, comparing 1990 and 2015, in Brazil and Federated Units, using estimates produced by the Global Burden of Disease 2015 (GBD 2015). METHODS:: Secondary data analysis of estimates from the GBD 2015, producing standardized death rates and years of life lost due to death or disability. The main source of death data was the Mortality Information System, submitted to correction of underreporting of deaths and redistribution of garbage codes. RESULTS:: From 1990 to 2015, homicide mortality rates were stable, with a percentage variation of -0.9%, from 28.3/100 thousand inhabitants (95% UI 26.9-32.1) in 1990 to 27.8/100,000 (95% UI 24.3-29.8) in 2015. Homicide rates were higher in Alagoas and Pernambuco, and there was a reduction in São Paulo (-40.9%). Suicide rates decreased by 19%, from 8.1/100,000 (95% UI 7.5-8.6) in 1990 to 6.6/100,000 (95% UI 6.1-7,9) in 2015. Higher rates were found in Rio Grande do Sul. In the ranking of external causes for years of life lost due to death or disability (DALYs), firearm aggression predominated, followed by transportation accidents; self-inflicted injuries were in sixth place. CONCLUSIONS:: The study shows the importance of external causes among young people and men as a cause of premature death and disabilities, which is a priority problem in the country. The Global Burden of Disease study may support public policies for violence prevention.

Mortalidade e anos de vida perdidos por violências interpessoais e autoprovocadas no Brasil e Estados: análise das estimativas do Estudo Carga Global de Doença, 1990 e 2015 / Mortality and years of life lost by interpersonal violence and self-harm: in Brazil and Brazilian states: analysis of the estimates of the Global Burden of Disease Study, 1990 and 2015

RESUMO: Objetivo: Analisar a mortalidade e os anos de vida perdidos por morte ou incapacidade (Disability-Adjusted Life Years - DALYs) por violências interpessoais e autoprovocadas, comparando 1990 e 2015, no Brasil e nas Unidades Federadas, utilizando estimativas produzidas pelo estudo Carga Global de Doença 2015 (GBD 2015). Métodos: Análise de dados secundários das estimativas do GBD 2015, com produção de taxas padronizadas de mortes e DALYs. A principal fonte de dados de óbitos foi o Sistema de Informações sobre Mortalidade, submetido à correção do sub-registro de óbitos e redistribuição de códigos garbage. Resultados: De 1990 a 2015, observou-se estabilidade das taxas de mortalidade por homicídios, com variação percentual de -0,9%, passando de 28,3/100 mil habitantes (II 95% 26,9-32,1), em 1990, para 27,8/100 mil (II 95% 24,3-29,8), em 2015. As taxas de homicídio foram mais altas em Alagoas e Pernambuco, e ocorreu redução em São Paulo (-40,9%). As taxas de suicídio variaram em -19%, saindo de 8,1/100 mil (II 95% 7,5-8,6), em 1990, para 6,6/100 mil (II 95% 6,1-7,9), em 2015. Taxas mais elevadas ocorreram no Rio Grande do Sul. No ranking de causas externas por Disability-Adjusted Life Years (DALYs), predominaram as agressões por arma de fogo, seguidas de acidentes de transporte e em sexto lugar lesões autoprovocadas. Conclusões: O estudo aponta a importância das causas externas entre jovens e homens na morte prematura e em incapacidades, constituindo um problema prioritário no país. O estudo Carga Global de Doença poderá apoiar políticas públicas de prevenção de violência.

ABSTRACT: Objective: To analyze mortality and years of life lost due to death or disability (disability-adjusted life years - DALYs) for interpersonal violence and self-harm, comparing 1990 and 2015, in Brazil and Federated Units, using estimates produced by the Global Burden of Disease 2015 (GBD 2015). Methods: Secondary data analysis of estimates from the GBD 2015, producing standardized death rates and years of life lost due to death or disability. The main source of death data was the Mortality Information System, submitted to correction of underreporting of deaths and redistribution of garbage codes. Results: From 1990 to 2015, homicide mortality rates were stable, with a percentage variation of -0.9%, from 28.3/100 thousand inhabitants (95% UI 26.9-32.1) in 1990 to 27.8/100,000 (95% UI 24.3-29.8) in 2015. Homicide rates were higher in Alagoas and Pernambuco, and there was a reduction in São Paulo (-40.9%). Suicide rates decreased by 19%, from 8.1/100,000 (95% UI 7.5-8.6) in 1990 to 6.6/100,000 (95% UI 6.1-7,9) in 2015. Higher rates were found in Rio Grande do Sul. In the ranking of external causes for years of life lost due to death or disability (DALYs), firearm aggression predominated, followed by transportation accidents; self-inflicted injuries were in sixth place. Conclusions: The study shows the importance of external causes among young people and men as a cause of premature death and disabilities, which is a priority problem in the country. The Global Burden of Disease study may support public policies for violence prevention.

Evaluation of Non-Natural Deaths among Veterans: New Mexico Medical Examiner-Investigated Deaths, 2002-2011.

While it is recognized that veterans have increased rates of depression, post-traumatic stress disorder (PTSD), suicide, and substance use disorders, rates of homicide and unintentional injury deaths in veterans have been minimally investigated. We evaluated all non-natural deaths in New Mexico veterans between 2002 and 2011 in comparison with non-natural deaths among non-veterans. We reviewed all decedents in New Mexico with a history of military service and investigated by the medical examiner, excluding natural deaths and deaths due to fall from standing height. The most common manner of death was unintentional injury (62%), most of these deaths due to motor vehicle accidents (29%) followed by unintentional overdose (26%). Suicide rates among veterans were consistently higher than the general population. The most common mechanism of suicide in men was gunshot wound (72%), and intentional overdose in women (49%). Services are needed for veterans that are tailored to all ages and both sexes.

Review of deaths correction methods and quality dimensions of the underlying cause for accidents and violence in Brazil. / Revisão dos métodos de correção de óbitos e dimensões de qualidade da causa básica por acidentes e violências no Brasil.

This review article aims to perform analysis and critical discussion about the literature on methods correcting mortality from accidents and violence reported to the Brazilian Mortality Information System. We consulted Medline and SciELO databases, as well as the Global Burden of Disease site, using time filter for the 1996-2015 interval. Of the 77 studies identified, we selected 29, and 14 met the corrections production criteria for cases of underreporting: underreporting of deaths in the Mortality Information System, deaths declared as ill-defined causes or deaths from external causes declared with nonspecific codes. We found that the underreporting of external causes was not significantly different from what occurs in total deaths and sometimes was higher in small and medium-sized municipalities. The reclassification of ill-defined causes of death corrected external causes to non-negligible values. The selected studies differ on proposals for correction of unspecified external causes. Evidence supports interventions to improve the quality of data, and the availability of correction procedure of external causes that bring together application conditions.

Mortalidad pediátrica por lesiones no intencionales en La Habana. 2003-2012 / Pediatric mortality for non intentional injury in Havana. 2003-2012

Introducción: los accidentes o lesiones no intencionales representan un problema de salud mundial. La población pediátrica es aún más vulnerable. Objetivo: describir las causas de mortalidad ocurridas por lesiones no intencionales en menores de 15 años en La Habana entre 2003 y 2012. Material y Método: se realizó un estudio descriptivo de 216 defunciones por accidentes ocurridas durante 2003 a 2012 en edades de 0-14 años, según datos ofrecidos por el Departamento de Estadísticas de la Dirección Provincial de Salud. Las variables estudiadas fueron: año, edad, sexo, municipio de residencia y tipos de accidentes, según la Clasificación Internacional de Enfermedades. Se estimaron porcentajes, se elaboraron tablas y figuras mediante el programa XLSTAT y se calculó la tasa x 100, 000 habitantes. Resultados: la mortalidad mostró tasas decrecientes de 0,92 y 0,76 en 2003 a 0,68 y 0,25 en 2012 según el sexo masculino y femenino, respectivamente. Las causas que mostraron mayor frecuencia resultaron ser: tránsito 41,2 por ciento, ahogamientos 24 por ciento, asfixia 6,4 por ciento e intoxicación 5,5 por ciento. Los adolescentes, escolares y pre-escolares como peatones fallecieron en mayor proporción por accidentalidad vial. Los ahogamientos ocurrieron en su mayoría en escolares (40,3 por ciento) y pre-escolares (30,7 por ciento) en piscinas y mar, ambos con 19,2 por ciento,y lugares sin seguridad acuática (26,9 por ciento). La intoxicación mostró igual proporción en adolescentes y pre-escolares (46,1 por ciento); la asfixia en lactantes alcanzó 84,6 por ciento. Los accidentes de tránsito y ahogamientos exhibieron mayores defunciones en el municipio Boyeros.Conclusiones: la mortalidad por accidentes aun representa un problema cardinal de salud en pediatría(AU)

Introduction: unintentional accidents and injuries mean a world health problem, and turn out to be the first pediatric cause of death. Objective: to describe the epidemiologic behavior of pediatric mortality due to unintentional accidents and injuries in Havana. Material and Methods: a descriptive and retrospective study about 216 deaths by this cause that did occurs between 2003-2012, in ages from 0-14 years old, according to data offered by the statistic department of the provincial health headquarters, and the variables studied were: year, age, sex, municipality, drowning sites, and kinds according to the international classification of diseases X edition. The percentage method was used; tables and graphs were made by means of the program XLSTAT, the rates were calculated x 100 000 inhabitants. Results: decreasing death rates in the decade from 0, 92 and 0, 76 (2003) to 0, 68 y 0, 25 (2012) in males and females respectively. The most frequent causes were: traffic (41,2 percent), drowning (24 percent), suffocation (6,4 percent), and intoxication (5,5 percent). The adolescents and schoolmate pedestrian died in more proportion for traffic accidents. The drowning, happening mostly in school (40,3 percent) and pre-school (30,7 percent) in pools and sea both with 19,2 percent and places without security aquatic 26,9 percent. The intoxication showed up same proportion in adolescent and pre-school with 46,1 percent and the asphyxia in nurslings with 84,6 percent. The traffic accidents and drowning showed bigger deaths in the municipality Boyeros.Conclusions: Mortality due to accidents still turns out to be a cardinal health problem in pediatric ages(AU)

Revisão dos métodos de correção de óbitos e dimensões de qualidade da causa básica por acidentes e violências no Brasil / Review of deaths correction methods and quality dimensions of the underlying cause for accidents and violence in Brazil

Resumo Este artigo de revisão tem como objetivo realizar análise e discussão crítica da literatura sobre métodos de correção da mortalidade por acidentes e violências notificados ao Sistema de Informações sobre Mortalidade-SIM. Foram consultadas as bases Medline e Scielo, e o site do Global Burden of Disease, com uso de filtro temporal de 1996 a 2015. De 77 estudos identificados, 29 foram inicialmente selecionados, e 14 atendiam ao critério de produção de correções para um dos casos de subinformação: sub-registro de óbitos ao SIM, declaração do óbito no SIM devido a causas mal definidas, ou devido a causas externas não definidas (declaradas com códigos inespecíficos). Verificou-se que o sub-registro das causas externas não se mostrou muito diferente do relativo aos óbitos totais, e em alguns casos foi maior, em municípios de porte pequeno e médio. A reclassificação das causas mal definidas corrigiu as externas a valores não desprezíveis. Os estudos divergem nas propostas de correção das causas externas não definidas. Há evidências que sustentam intervenções para aprimoramento da qualidade dos dados, e ainda a disponibilidade de modelos de correção das causas externas que reúnem condições de aplicação.

Abstract This review article aims to perform analysis and critical discussion about the literature on methods correcting mortality from accidents and violence reported to the Brazilian Mortality Information System. We consulted Medline and SciELO databases, as well as the Global Burden of Disease site, using time filter for the 1996-2015 interval. Of the 77 studies identified, we selected 29, and 14 met the corrections production criteria for cases of underreporting: underreporting of deaths in the Mortality Information System, deaths declared as ill-defined causes or deaths from external causes declared with nonspecific codes. We found that the underreporting of external causes was not significantly different from what occurs in total deaths and sometimes was higher in small and medium-sized municipalities. The reclassification of ill-defined causes of death corrected external causes to non-negligible values. The selected studies differ on proposals for correction of unspecified external causes. Evidence supports interventions to improve the quality of data, and the availability of correction procedure of external causes that bring together application conditions.

[Trend in mortality from external causes in pregnant and postpartum women and its relationship to socioeconomic factors in Colombia, 1998-2010]. / Tendencia de la mortalidad por causas externas en mujeres gestantes o puérperas y su relación con factores socioeconómicos en Colombia, 1998-2010.

OBJECTIVE: Determine the trend in mortality from external causes in pregnant and postpartum women and its relationship to socioeconomic factors. METHODS: Descriptive study, based on the official registries of deaths reported by the National Statistics Agency, 1998-2010. The trend was analyzed using Poisson regressions. Bivariate correlations and multiple linear regression models were constructed to explore the relationship between mortality and socioeconomic factors: human development index, Gini index, gross domestic product, unsatisfied basic needs, unemployment rate, poverty, extreme poverty, quality of life index, illiteracy rate, and percentage of affiliation to the Social Security System. RESULTS: A total of 2 223 female deaths from external causes were recorded, of which 1 429 occurred during pregnancy and 794 in the postpartum period. The gross mortality rate dropped from 30.7 per 100 000 live births plus fetal deaths in 1998 to 16.7 in 2010. A downward curve with no significant inflection points was shown in the risk of dying from this cause. The multiple linear regression model showed a correlation between mortality and extreme poverty and the illiteracy rate, suggesting that these indicators could explain 89.4% of the change in mortality from external causes in pregnant and postpartum women each year in Colombia. CONCLUSIONS: Mortality from external causes in pregnant and postpartum women showed a significant downward trend that may be explained by important socioeconomic changes in the country, including a decrease in extreme poverty and in the illiteracy rate.

Caracterización epidemiológica de las lesiones no intencionales en Villa Clara (2001-2012) / Epidemiological characterization of unintentional lesions in Villa Clara (2001-2012)

En la provincia Villa Clara, fallecieron por accidentes en los últimos 12 años, 230 menores de 20 años como consecuencia de lesiones no intencionales. El mayor número de fallecidos se produjo en el 2001, cifra que se incrementó en el 2012. Existió un predominio marcado de la mortalidad en el sexo masculino, con 179 fallecidos (77,8 por ciento), con similar comportamiento en todos los años. El grupo de edad de 15 a 19 años presentó el mayor riesgo de accidentes por mostrar las tasas más elevadas. El mayor riesgo se presentó en los municipios de Encrucijada, Ranchuelo, Sagua y Camajuaní. Según causas de ocurrencia, se observó un predominio de los accidentes de transporte (43,5 por ciento), seguido del ahogamiento y la sumersión (18,7 por ciento). La mortalidad por accidentes fue más frecuente entre mayo y agosto, con un pico máximo en junio y agosto(AU)

Quemaduras accidentales en niños y niñas remitidos del nivel primario de atención / Accidental burns in children transferred from primary care level

Se realizó un estudio descriptivo y transversal de 58 pacientes con quemaduras, ingresados en el Servicio de Caumatología del Hospital Infantil Norte Docente Juan de la Cruz Martínez Maceira de Santiago de Cuba, remitidos del nivel primario de atención, desde enero de 2009 hasta diciembre de 2010, con el objetivo de investigar los factores más frecuentes que ocasionaron estos accidentes. En la serie predominaron el sexo masculino, los líquidos hirvientes como agente causal más frecuente, además de la baja percepción del riesgo, las malas condiciones de vida y la procedencia rural como factores socioeconómicos desfavorables. La atención médica se consideró satisfactoria ya que más de 50 % de los pacientes ingresaron entre graves y críticos extremos y solo dos 2 fallecieron(AU)

A descriptive and cross-sectional study of 58 patients transferred from the primary care level with burns, and admitted in the Caumatology Service of "Juan de la Cruz Martínez Maceira" Children Northern Teaching Hospital in Santiago de Cuba, was carried out from January, 2009 to December, 2010, with the objective of investigating the most frequent factors causing these accidents. The male sex, and boiling liquids prevailed in the series as the most frequent causal agent, besides the low perception of risk, the bad living conditions and the rural origin as unfavorable social and economic factors. The medical care was considered satisfactory since more than 50% of the patients were admitted as severely and critically injured and only two of them died(AU)